| NPI | 1538120530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2828) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02246) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2012-04-27 |